Emergency Response outside the Envelope: The District of Columbia's Former Chief Health Officer Considers the Lessons Learned from the Response to the Spate of Deadly Anthrax-Infected Letters. (Focus On: Emergency Preparedness)

Emergency Response outside the Envelope: The District of Columbia's Former Chief Health Officer Considers the Lessons Learned from the Response to the Spate of Deadly Anthrax-Infected Letters. (Focus On: Emergency Preparedness)

Article excerpt

In December 2002, more than a year after anthrax-laden letters were sent to the Washington, D.C., offices of two U.S. Senators, authorities were still working to clean the mail processing center through which the letters had passed. While authorities called the fumigation process a success, the Washington, D.C., facility, which has been closed since October 2001, is not expected to reopen until late spring. That's just one indication of the extent to which the anthrax attacks presented extraordinary challenges to all of the various government and private groups charged with emergency response and disaster management in the region.

The problems that ensued from the anthrax incident were not the result of a lack of planning. Some basic planning for disaster response and counterterrorism (including bioterrorism) had been conducted before that event as a joint effort by the Metropolitan Washington Council of Governments (MWCOG), a regional organization comprising 17 local governments surrounding the nation's capital and selected members of the Maryland and Virginia legislatures, the U.S. Senate, and the U.S. House of Representatives.

But the anthrax attacks revealed a number of deficiencies in the MWCOG's basic disaster response plan. One shortcoming was that while the response plan considered a range of scenarios, it lacked the specific operational details that were necessary to ensure a smooth response to a crisis. For example, while there was a general requirement that the member agencies communicate with each other, no guidelines existed to tell participants how this communication should take place.

As chief health officer for the District of Columbia during the anthrax crisis, the author was given the role of incident commander during the emergency, responsible for the coordination of local, regional, and federal resources. Some of these tasks involved directing physical assets, such as ensuring that law enforcement agencies were providing crowd control measures where needed and getting property managers to open necessary facilities and keep them running around the clock.

Other tasks involved the dissemination to emergency response team members of critical information such as the reports from hazmat teams about other possible anthrax events, and information coming in from the Centers for Disease Control and Prevention (CDC) and other states (New York and New Jersey were also experiencing anthrax events).

Through this involvement, the author experienced firsthand the strengths and weaknesses of the region's disaster response planning. This article highlights the most important lessons learned (specifically with regard to information sharing and incident command training) and suggests some changes for the future.

Background. Before exploring these issues, a brief review of the anthrax affair as it played out in the Washington, D.C., region will help to set the discussion in the proper context. On October 15, 2001, an aide to Senator Tom Daschle (D-SD) opened a letter that contained anthrax spores. Public health officials had little experience with anthrax, and there was no reason to believe that anybody outside Daschle's office would be affected, as there was so far no evidence that the spores could infect anybody (such as postal workers) who bad contact with the contaminated-but-sealed envelopes. (Weeks earlier, anthrax-contaminated letters had been received in both Florida and New York; one person had already died, and several people were infected. It was not until after Daschle's office received the contaminated letters that the first spores were discovered in mail processing facilities, however.)

Although the author's office did not have jurisdiction, the existing bioterrorism attack plan called for D.C. to activate its emergency response protocol. The first step was to contact the CDC, which would examine the letters for anthrax. The author also contacted the Attending Physician of the U. …